Pyridoxal-5-phosphate (P5P) should be administered to all neonates who have epileptic seizures and have not responded to first-line treatment.
The incidence of seizures is higher in the neonatal period than at any other time of life (0.7 to 2.7 per 1000 live births) [1, 2]. The first-line treatment is phenobarbital. Response to the treatment is 50% [3]. In nonresponders, the possibility of vitamin-sensitive epilepsy should be considered. There are two main entities: pyridoxonidependent epilepsy (OMIM 266100) and pyridoxamine 5-phosphate oxidase deficiency (OMIM 610090). In these two diseases, early administration of pyridoxal phosphate may control the epileptic seizures. The recommendations are therefore to treat all neonates and young babies who have epileptic seizures not responding to the first-line treatments. If the diagnosis is confirmed, the treatment is administered for life.
Pyridoxal-5-phosphate or pyridoxal phosphate, also designated P5P or P5P-H hereinafter, is a vitamin that is indispensable in the management of neonatal epileptic seizures and will be maintained for life in patients for whom the diagnosis of vitamin-sensitive epilepsy is confirmed. To date, there is no pharmaceutical specialty intended for humans in a form that is suitable for pediatrics. P5P is currently supplied to some neonatal medicine departments in the form of preparations produced according to customary local conditions, generally containing microcrystalline cellulose. Administration of these to neonates is difficult, as P5P has low water-solubility, a phenomenon that is characterized by the yellowish solid residue observed on the dissolution device. The clinical consequence is incomplete administration of the dose, as well as a loss of the nurse's time.